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NPI Code Detail

MEDICARE: DOKKO WELLNESS SERVICES LLC

MEDICARE: DOKKO WELLNESS SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1181.012798OTHERILSTATE OF ILLINOIS-DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
21316437809OTHERNPPES (NPI 1)

General Provider Information

NPI Number : 1801460548
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOKKO WELLNESS SERVICES LLC
Provider Business Mailing Address
First Line : 6711 N LORON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60646-1409
Country : US
Telephone Number : 303-810-3144
Fax Number :
Provider Business Practice Location Address
First Line : 17 N WABASH AVE STE 515
Second Line :
City : CHICAGO
State : IL
Zip : 60602-4818
Country : US
Telephone Number : 773-809-3528
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. AIMEE DOKKO OSBORNE
Credential : LCPC, NCC
Telephone Number : 773-809-3528
Provider Enumeration Date : 05/17/2021
Last Update Date : 05/17/2021

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